Echocardiographic Parameters and Athlete Performance: Associations and Training Profile Comparisons

Purpose: This study investigated standard and advanced echocardiographic parameters in endurance athletes with different training profiles, and their association with exercise performance. Methods: Consecutive endurance athletes undergoing cardiological screening or orthopedic evaluation for knee injuries at Campus Bio-Medico University Hospital underwent advanced echocardiography and cardiopulmonary exercise testing. Athletes were categorized into three groups: (1) Long-Distance (marathon and ultramarathon runners, n = 30); (2) Mid-Distance (middle-distance runners, n = 27); and (3) Detrained (≥ 6 months training interruption, n = 31). Results: Left ventricular ejection fraction did not differ among groups. The Long-Distance group had the highest stroke volume index, followed by the Mid-Distance and Detrained groups (p <0.001). Long-Distance athletes showed lower left ventricular global longitudinal strain (p = 0.003) and left atrial reservoir strain (p = 0.003) compared to the other groups, with no differences in right ventricular free wall strain. Myocardial work analysis showed higher work index and constructive work, and lower wasted work, leading to greater global work efficiency in the Long-Distance group (p <0.001). In multivariable linear regression analysis, stroke volume index (β = 1.02, p < 0.001) and global work efficiency (β = 1.00, p = 0.001) were independently associated with Peak VO2, whereas global longitudinal strain was not. Conclusion: Advanced echocardiography provides additional insights into the athlete's heart. Myocardial work indices reflect training-related cardiac adaptations, and left atrial reservoir strain is influenced by training status. These findings, together with the association of stroke volume index and global work efficiency with Peak VO2, support the integration of advanced echocardiographic parameters into athlete evaluation and monitoring.